“Hey MFCU! What do you think you’re doing?”
Yes, ‘MFCU” sounds like it might be some sort of veiled insult, but in reality, it is quite the opposite. It’s a force for good in the nefarious world of healthcare fraud, patient abuse, and neglect.
Learn more about these essential investigation units and get in touch with one of our Atlanta whistleblower attorneys for more guidance.
What is an MFCU?
So what is an MFCU exactly? Well, let’s have the Office of the Inspector General (OIG), the designated Federal agency that oversees and annually approves Federal funding for MFCUs, describe it for you:
“Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect.
The Social Security Act (SSA) requires each State to effectively operate an MFCU, unless the Secretary of Health and Human Services (HHS) determines that (1) the operation of a Unit would not be cost-effective because minimal Medicaid fraud exists in a particular State; and (2) the State has other adequate safeguards to protect enrollees from abuse or neglect.
In fiscal year (FY) 2022, all 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands operated MFCUs.”
Each state administers its own Medicaid program, which provides health care funding for low-income families or individuals, but Medicaid is funded jointly by state and federal governments.
Thus, the state and federal governments jointly fund MFCUs, with the federal government providing 75% of MFCU funding and the state providing the balance.
Continuing with the parade of acronyms, there is also “NAMFCU” (pronounced Nam-Foo-Koo), which is the National Association of Medicaid Fraud Control Units. NAMFCU was founded in 1978 and comprises MFCUs across the country.
How does all of this relate to what we do at Bracker & Marcus LLC?
Whistleblower claims under the False Claims Act often involve Medicaid fraud, which means that an MFCU will be involved in the investigation.
In cases where the whistleblower is alleging Medicaid fraud claims that span multiple states, NAMFCU steps in to assist the various MFCUs involved in investigating the claims. It has enabled MFCUs to, “Deter some of the largest and most insidious health care provider frauds, recover program dollars, punish corrupt practitioners, and prosecute those who abuse or neglect nursing home residents.”
How much fraud prevention are we talking about here?
I’m glad you asked! Every year, the OIG releases a report that summarizes the successes of MFCUs nationwide. The OIG analyzes the annual statistical data on case outcomes.
The OIG just released the MFCU report for 2022 revealing that MFCUs recovered a total of $1.1 billion. This means that MFCUs are definitely earning their keep – returning $3.08 to the taxpayers for every $1 spent.
The report also included the following data regarding MFCU’s 2022 efforts:
- 1,327 convictions comprised 946 convictions for fraud and 381 convictions for patient abuse and neglect
- In 2022, the total convictions resulting from MFCU cases continued to increase from the FY 2020 level but remained lower than in FY 2019.
- 1,1018 individuals or entities were excluded from federally funded health programs as a result of these convictions.
- Compared to other provider types, Personal Care Services (PCS) attendants had the highest number of fraud convictions each year during FYs 2018 through 2022.
- 553 civil settlements and judgments
- The total number of civil settlements and judgments reported by MFCUs decreased in FY 2022, as did the total number of civil settlements and judgments associated with pharmaceutical manufacturers.
- Even with that decline, pharmaceutical manufacturers continued to account for more civil settlements and judgments than any other provider type. Following pharmaceutical manufacturers, medical device manufacturers and retail and institutional wholesale pharmacies had the next highest number of civil settlements and judgments.
- $641 million in civil recoveries, with 62% occurring in non-global cases and 38% occurring in global cases
- A global case is a civil case that involves both the Federal Government and a group of States and is coordinated by NAMFCU. A non-global case is a civil case conducted by an MFCU—individually or with other law enforcement partners—and is not coordinated by NAMFCU.
- One global case resolved in FY 2022 involved all 50 States, Washington D.C., and Puerto Rico partnering with Federal agencies to pursue allegations that a Mallinckrodt ARD, LLC (formerly known as Questcor Pharmaceuticals, Inc.), a U.S. subsidiary of the Irish pharmaceutical company Mallinckrodt plc (collectively Mallinckrodt), a pharmaceutical manufacturer, knowingly underpaid Medicaid drug rebates. As a result of the investigation, the pharmaceutical manufacturer agreed to pay a total of $234 million.
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If you know of Medicare or Medicaid fraud, give us a call at Bracker & Marcus LLC – we would be happy to provide you with a free consultation and help you determine your best course of action.